Wartime vascular injuries in the pediatric population of Iraq and Afghanistan: 2002â•fi2011

a r t i c l e i n f o Background: Contemporary war-related studies focus primarily on adults with few reporting the injuries sustained in local pediatric populations. The objective of this study is to characterize pediatric vascular trauma at US military hospitals in wartime Iraq and Afghanistan. Methods: Review of the Department of Defense Trauma Registry (DoDTR) (2002–2011) identified patients (1– 17 years old) treated at US military hospitals in Iraq and Afghanistan using ICD-9 and procedure codes for vascular injury. Results: US military hospitals treated 4402 pediatric patients between 2002 and 2011. One hundred fifty-five patients (3.5%) had a vascular injury. Mean age, gender, and injury severity score (ISS) were 11.1 ± 4.1 years, 79% male, and 34 ± 13.5, respectively. Vascular injuries were primarily from penetrating mechanisms (95.6%; 58.0% blast injury) to the extremity (65.9%), torso (25.4%), and neck (8.6%). Injuries were ligated (31%), reconstructed (63%), or observed (2%). Limb salvage rate was 95%. Mortality rate was 9%. Conclusions: This study is the first to report vascular trauma in a pediatric population at wartime. Vascular injuries involve a high percentage of extremity and torso wounding. Torso vascular injury in children is four times lethal relative to other injury patterns, and therefore should be considered in operational planning both in the military and civilian setting regarding pediatric vascular injuries. Published by Elsevier Inc. Wartime vascular injury among adult combatants is well described , with an incidence of 12% most often involving extremity vessels [1]. As the counter insurgency wars in Iraq and Afghanistan have been largely conducted in the vicinity of civilian populations, pediatric casualties have been sustained [2,3]. However, the incidence of vascular injury during wartime in a pediatric population has not been previously reported. In a peacetime environment, vascular injuries constitute 0.3% of pediatric trauma admissions; although rare, they are associated with significant morbidity and mortality [4,5]. In contrast to the management of adult vascular injuries, there is little established evidence for the management of pediatric vascular injury. Lessons learned from military conflicts have proven vital in advancing adult treatment modalities for vascular trauma, allowing great progress for the adult population [6]. It is unclear whether these advances have extended to pediatric vascular trauma. The aim of this study is to characterize pediatric vascular trauma, including injury patterns, management strategies, and outcomes at US military hospitals during the wars in Iraq and Afghanistan. These insights …